Clinical Healthcare Professional

20 hours ago

Manila, National Capital Region, Philippines beBeeNurse Full time ₱50,000 - ₱68,000

We are seeking a dedicated and experienced Clinical Nurse Case Manager to manage the full lifecycle of patient care.

Key Responsibilities:
  • Conduct thorough reviews of service requests to ensure compliance with applicable criteria, medical policy, and member eligibility, benefits, and contracts.
  • Utilize client-specific criteria sets, medical policy, and clinical guidelines for decision-making to approve or summarize and route to Client's nursing reviewer and/or medical staff for review.
  • Ensure members have access to medically necessary, quality healthcare in a cost-effective setting according to the contract.
  • Consult with clinical reviewers and/or licensed medical directors to guarantee medically appropriate, high-quality care throughout the medical management process.
Required Skills and Qualifications:
  • Active and Non-Active USRN License
  • At least 1 year of clinical or hospital experience as an RN

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